Adjuvant Chemotherapy Versus Observation For Resected NSCLC:a Meta-analysis

Objective:We adopted a Meta-analysis to analyze on the effect of platinum-based adjuvant chemotherapy in the resected stage I-III NSCLC patients.Materials and Methods:The relevant RCTs have been retrieved from the Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and CNKI database up to December2012. The search terms used include ’non-small cell lung cancer’,’resection’,’adjuvant chemotherapy’and ’platinum-based recipe’. The search language include English and Chinese. We assess four aspects of every RCT with the unified inclusion criteria and these four aspects are’study type’,’patients in study’,’intervention versus control’and’outcome of the study’. Only these aspects fulfilled a study can be chosen. The quality of these chosen RCTs has been assessed by the criteria from the Cochrane Reviewer Handbook version5.1.0and all these RCTs will be graded from A to C. The five-year mortality is used to assess the effectiveness of the relevant intervention. We adopted the software Revman version5.1.7to do the Meta-analysis procedure and this software is provided by the Cochrane Collaboration Network.Result:At first we have found11,270items. There are4,739items in English and6,531items in Chinese. After checking the title and abstract we excluded the duplicate and the obvious ineligible items and in this step the number of excluded items is11,216. Then we checked the rest eligible54items by reading the full text and assessing the study quality and there are39items excluded. In this step the exclusion reason focused on whether a study is a real RCT. In the end we included15RCTs and all these RCTs are published in English. The overall included participants reached5,530. There are2,750persons in the chemotherapy arm and2,780persons in the observation arm. After assessed by the Cochrane Reviewer Handbook version5.1.0quality criteria all these15RCTs received grade B.In the5,530patients from these included15RCTs there are2966dead cases after more than five years follow-up and the causes of death are attributed to the tumor relapse and metastasis. The five-year mortality is lower in chemotherapy arm than observation arm and the RR value is0.87. The difference is statistically significant (95%CI=[0.81,0.94], P=0.0007). Conclusion:As compared to observation the platinum-based adjuvant chemotherapy can significantly reduce the five-year mortality in the resected stage Ⅰ-Ⅲ NSCLC patients. This conclusion showed that the platinum-based adjuvant chemotherapy is effective in the resected stage I-III NSCLC patients.